Evidence map›Paper›PMID 40258634›Full record

SynthesisBMJ global health2025

Global maternal mortality associated with SARS-CoV-2 infection: a systematic review and meta-analysis.

Kathryn Barry, Silvia Fernández-García, Alya Khashaba, Gabriel Ruiz-Calvo, Miriam Roncal Redin, Ghadir Mahmoud, Magnus Yap, Yasmin King, Dengyi Zhou, Massa Mamey and 28 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Predictors of COVID-19 Pandemic-Related Pregnancy Stress: Prenatal and Postpartum Experiences in Canada.International journal of environmental research and public health · 2025
    Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

38 authors.

Kathryn BarryCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Silvia Fernández-GarcíaWHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK.ORCID http://orcid.org/0000-0002-5457-3002
Alya KhashabaCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Gabriel Ruiz-CalvoClinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
Miriam Roncal RedinHospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
Ghadir MahmoudCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Magnus YapCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Yasmin KingMedical School, University of Nottingham, Nottingham, UK.
Dengyi ZhouCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Massa MameyCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Isabella Shepherd-EvansCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Jameela SheikhCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.ORCID http://orcid.org/0000-0002-6409-6940
Heidi LawsonCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Tania KewCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Kehkashan AnsariCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Shruti AttardeCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Adeolu BanjokoCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Helen FraserCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Megan LittmodenCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Tanisha RajahCollege of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Kate WalkerMedical School, University of Nottingham, Nottingham, UK.
Keelin O'DonoghueUniversity College Cork, Cork, Ireland.
Madelon van WelyNetherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Elizabeth van LeeuwenDepartment of Obstetrics Gynecology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Elena KostovaNetherlands Satellite of the Cochrane Gynaecology and Fertility Group, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Heinke KunstBlizard Institute, Queen Mary University of London, London, UK.
Asma KhalilSt George's University of London, London, UK.
Vanessa BrizuelaUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.ORCID http://orcid.org/0000-0002-4860-0828
Edna KaraUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Caron Rahn KimUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.ORCID http://orcid.org/0000-0002-3574-4160
Anna ThorsonUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.ORCID http://orcid.org/0000-0002-8703-6561
Olufemi T OladapoUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Lynne MofensonElizabeth Glaser Pediatric AIDS Foundation, Washington DC, District of Columbia, USA.ORCID http://orcid.org/0000-0002-2818-9808
Mercedes BonetUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.ORCID http://orcid.org/0000-0001-9015-1635
Javier ZamoraClinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
John AlloteyWHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK j.allotey.1@bham.ac.uk.
Shakila ThangaratinamInstitute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
PregCOV-19 Living Systematic Review Consortium

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundPregnant and recently pregnant women infected with SARS-CoV-2 are at increased risk of death and serious complications than those without the infection. The extent of variation in mortality rates in pregnant women with SARS-CoV-2 infection across regions, and the causes of death are not known. We systematically reviewed all available evidence on the variation in mortality rates in pregnant women with SARS-CoV-2 infection across geographical and country income groups, and the reported cause of death.

methodsWe searched major databases (December 2019-January 2023) including Medline, LILACS, BIREME and Embase. We included studies that reported deaths in at least 10 consecutive pregnant or recently pregnant women with confirmed SARS-CoV-2 infection and assessed the studies' risk of bias. We calculated the summary estimates of any cause of death as proportions with 95% CIs using a multilevel random-effects logistic regression model. Subgroup analyses were performed by geographical region and country income groups. We used International Statistical Classification of Diseases and Related Health Problems-Maternal Mortality to categorise the reported cause of death.

findingsFrom 1 326 315 citations, we included 169 studies (319 172 women with confirmed SARS-CoV-2 infection; 4253 women died). The overall rate of unspecified maternal death was 0.87% (95% CI 0.64% to 1.16%). There were significant differences between geographical regions in rates of maternal mortality, with the highest rates in Sub-Saharan Africa (3.48%; 95% CI 0.66% to 16.42%) and Latin America and the Caribbean (3.16%, 95% CI 1.53% to 6.43%). Rates of maternal mortality varied by country income groups, with the highest rates in low-income countries (4.66%, 95% CI 0.75% to 24.07%). Among women with reported cause of death, 98.6% (2,390/2,423) of deaths were attributable to COVID-19.

interpretationRates of deaths in pregnant and recently pregnant women with SARS-CoV-2 infection vary significantly across regions and by country income groups, with the highest burden in Sub-Saharan Africa and low-income countries. COVID-19 is the main reported cause of death. PROSPERO REGISTRATION NUMBER: CRD42020224120.

Indexed as

COVID-19Global HealthMaternal MortalityPregnancy Complications, InfectiousCause of DeathFemaleHumansPregnancySARS-CoV-2Maternal healthSARS

Identifiers

PMID40258634
PMCPMC12015698

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.